445202518-7-26-2024-26-AS-JJIN-D872W3-20240815174452

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 445202518
Report Date: 04/19/2024
Date Signed: 07/26/2024 05:03:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/05/2024 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20240405133726

FACILITY NAME:	ALEXANDRIA VICTORIA		FACILITY NUMBER:	445202518
ADMINISTRATOR:	JOHN GRYSPOS, JR.		FACILITY TYPE:	740
ADDRESS:	226 MORRISSEY BOULEVARD		TELEPHONE:	(831) 429-9137
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95062
CAPACITY:	13	CENSUS: 8	DATE:	04/19/2024
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	John Gryspos Jr.		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility staff handled resident in a rough manner
Facility staff spoke inappropriately to resident

INVESTIGATION FINDINGS:

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*This report was amended on 07/26/2024 to change the allegation finding from unfounded to unsubstantiated.* Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Administrator John Gryspos Jr. LPA Marrufo reviewed resident records and determined that the alleged victim of the allegations was not admitted to this facility. LPA interviewed 7 residents on 04/11/2024. 1 out of 7 interviewed residents stated to have observed a staff handle him/her in a rough manner and speak to residents inappropriately, although the resident could not identify the staff. On 07/26/2024, LPA interviewed 3 staff and Administrator. The three staff and the Administrator stated to have never observed staff handling residents in a rough manner or staff speaking inappropriately to residents. This agency has investigated the complaint allegations listed. Based on information from interviews conducted with residents and staff, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to provewas the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. This report reviewed with Administrator John Gryspos Jr. and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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